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Medicine > Gastro > Flashcards

Gastro Flashcards

1
Q

Ddx cause douleur crampiforme

A

1- constipation
2- Diarrhée: infectieuse (gastroentérite), colite ischemiques segmentaire, colite pseudomembraneuse (Hx ATB), appendicite pelvienne

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2
Q

Ddx dlr abdo continue

A

1- colique biliaire: dlr epigastre/hypochondre D post-prandial/nocturne, irrad dos (pointe omoplate), soulagement spontan 4-6h
2- Colique néphrétique: dlr costovert/flanc en coup de poignard c irrad possible ad organes genitaux externes, sx urinaires irritatifs, pas de pstn antalgique

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3
Q

Ddx dlr abdo continue c toxicité

A

1- Pas de peritonisme
A) colite ischémique segmentaire: Diarrhée + rectorragie
B) thrombose mesenterique
2- peritonisme (defense + ressaut)
A) localisé: cholecystite, Hepatite, Appendicite, Diverticulite, Pancréatite
B) Généralisée: perforatiob colique (diverticule) ou gastrique (ulcère)

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4
Q

Ddx critères ictère BI vs BD

A

BI = urines claires, selles N, absence prurit, TFH =N

BD = urines foncées, selles décolorées, parfois prurit, TFH = aN

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5
Q

Ddx ictere c augmentation BI

A

Hemolyse

Maladie Gilbert

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6
Q

Ddx ictere c augm BD

A 
1- Vois biliaires N: 
  A) mx foie: hepatite, cirrhose
  B) Tumeur foie: benin, kyste, malin
  C) causes rares
2- vois biliaires dilatées 
  A) cholangiocarcinome
  B) lithiase
  C) ampullom vaterien
  D) Neo pancréatique
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7
Q

Complications choledociennes

A

Accident de migration

Ictère

Angiocholite

HTBiliaire

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8
Q

Triade de charcot angiocholite (cholangite)

A

Dlr hypochondre D

Fièvre

Ictère

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9
Q

Bacteries responsables de cholangite

A 
KEEPS
Klebsiella
E coli (50%)
Enterocoque/bacter
Proteus, Pseudomonas
Serratia

*1/4 = anaerobe (bacteroides, clostridium)
Hemoc + = 50%

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10
Q

Mnemonic cholangites

A 
CHOLANGITIS
Charcot's triad, Conj bili increase
Hepatic abces, Hepatic bile ducts obst
Obstruction
Leucocytosis
Alkaline phosphatase increase
Neo
Gallstone 
IBD (ulcerative colitis)
Transaminase increase
Infection 
Sclerosing
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11
Q

Ddx ictere pre-hepatique

A

Hemolyse

Hematome resorbe

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12
Q

Ddx ictere intra-hépatique

A

1- captation: Gilbert, Rx, neonat

2- liaison: Gilbert, Crigler-Najaf

3- conjugaison: Hepatites/ cirrhoses virales, toxiques, A-I

4- Excretion: Dubin-Johnson, rotor, bloc voies biliaires intra-hepatique, cirrhose biliaire primitive

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13
Q

Ddx ictere post hepatique

A

= obstruction voies biliaires extra-hepatiques

1- congenital: atresie

2- benin: calcul, stenose

3- malin: voie bili, pancreas e

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14
Q

Physiopatho ictère nv-né

A

Insuffisance glucuronyl transferase
Hemolyse GR foetaux
Immaturité foie
Augm act bet-glucuronidase bacterienne

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15
Q

MC hepatite A

A 
Apparition abrupte 
Moyenne : 30 jours
Fièvre 
No-Vo
Ictère (pas commun chez enfant)
Ig' anti-VHA
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16
Q

Mc hepatite B

A 
Apparition insidieuse
Moyenne: 8 jr
Arthralgie
Rash
No-Vo
Ag Hbs + IgM ac-HBc
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17
Q

Mc hepatite C

A

Apparition insidieuse
Moyenne: 50 jrs
No-Vo
ARN VHC

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18
Q

Mc hepatite D

A 
Apparition insidieuse 
Intervalle: 30-180 jr
Fievre
No-Vo
Ictere
IgM anti-VHD
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19
Q

MC hepatite E

A 
Apparition abrupte
Moyenne: 40 jr
Arthralgie
Rash
Fievre
No-Vo
Ictère 
IgM anti-VHE, ARN VHE
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20
Q

Hepatite virale chronique

Quel virus?

A

VHB
VHC
VHD

    • idem porteur chronique
    • idem association à neoplasies
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21
Q

Transmission hepatites virales

A 
VHA: PO, sex
VHB: PO, percutanée, sex (dans sperme), perinatale
VHC: percutanée (sang), perinatale
VHD: percutanée (sang), sex
VHE: fecale-orale, vecteurs animaix
22
Q

VHB AIGUE

Serologie

A

Ag Hbs +
IgM VHB +
Ag Hbe +

23
Q

VHB CHRONIQUE

Serologie

A

Ag Hbs +
IgG Hbc
Ag Hbe + ou -
Enzymes hepatiques N où augmentées

24
Q

Infection résolue VHB

Serologie

A

Anti-Hbs +_
IgG Hbc
AntiHbe +_

25
Q

Immunisation VHB

Serologie

A

Anti-Hbs +

26
Q

Investigations cirrhose

A

1- Biopsie: dx definitif
2- progression serologique: dim plaquette, augm INR, dim albumine, augm Bilirubine
3- imagerie: echo (avancée), CT (complications)
4- Endoscopie: varices/gastropathie portale

27
Q

Mnemonic complications cirrhose

A 
VARICES
Varices
Anemia ~> pancytopenie 2r hypersplenisme (plaquettes, puis Gb, puis Hb)
Renal failure
Infection
Coagulopathy
Encephalopathy
Sepsis
28
Q

Triade syndrome hepatopulmonaire

A

Maladie hepatique

Augmentation GAaO2 AA

AN vasculaire intrapulmonaire

  • dyspnee + platypnee + orthodexie
29
Q

Mc cirrhose

A
  • xanthelasma, Ictere a/n sclere
  • Haleine cétone
  • Angiome stellaire thorax
  • Gynecomastie, fonte musculaire
  • Érythème palmaire, contracture Dupuytren, asterixis, leukonychie, ongles de Terry, clubbing, ecchymose facile
  • Oedème cheville, dim poils sexuels, atrophie testicules
30
Q

Mc secondaire a hypertension portale

A 
Varices oesophagiennes
Varices gastriques ~> melena
Splenomegalie
Ascite
Hemorrhoides
Hernie/meduse ombilicale
31
Q

Ddx MC ulcere gastrique vs duodenale

A 
Gastrique = perte poids, dlr 1/2-1h apres repas, manger augm dlr, 
gastrique = gain de poids

Duod = dlr 2-3hr post-repas, manger dim dlr, prise poids

32
Q

Approche Hemorragie GI

A

SET
Stabilisation Hemodynamique: eval perte

Evaluation: nature, duree, sx, Rx (AINS, Aco, ROH), ATCD medicochx + EP (sv, coeur, poumon, abdo, TR) + labo (fsc, type sgn, electrolytes, uree-creat, facteur coag

Traitement: causal

33
Q

Questions importantes diarrhée aigue

A

<2 sem

  • voyage
  • Exposition: travail, maison, animaux
  • Fievre: suggère organisme invasif
  • Aliments crus: suggère ingestion toxine (Diarrhée en <6h)
34
Q

Quelle Diarrhée aigue ne necessite pas d’investigation?

A

= suspicion infection virale ~> diarrhée aqueuse non-sanguinolante et pas de sc systémique

35
Q

Tx Diarrhée aigue

A

1- tx support: Hydratation PO = meilleur
2- ATB empirique = PAS impact sur evol
-IMP NE PAS DONNER SI DIARRHEE ECOLI ENTEROHEMORRAGIQUE ~> augm risque HUS
3- Diète: liquides claires, aliments pauvres en fibre et mou, eviter lait + ROH + caféine
4- Si Diarrhée sans sang et fievre: loperamide (imodium)

36
Q

Questions importantes Diarrhée chronique

A
  • Diarrhée nocturne
  • volume Diarrhée
  • diarrhee sanguinolante ou graisseuse
  • incontinence fecale
37
Q

Tx H pylori

A

Tri therapie
2 ATB : Metronidazole + clarithromycine
1 IPP: Pantoprazole 40 mg
X 14 jours

38
Q

Complications maladie ulcéreuse

A

A- Saignement: maladie ulcereuse = cause #1 upper GI bleeding, FR #1 = AINS,
B- Perforation: mene a peritonite ~> epigastralgie soudaine + defense + rebond + rigidité
C- Gastric outlet obstruction: 2r à ulcère duodenale/pylorique

39
Q

MC colite ulcéreuse

A 
Diarrhée 
Dlr abdo
Urgence pour déféquer 
Rectorragie
Mucus dans selles
40
Q

Mc crohn

A

Selon segment GI impliqué (bouche a anus)

Frqt: Dlr QID, fièvre, perte poids, diarrhée, masse abdo palpable

41
Q

Mc systemiques MII

A 
#1 = arthrite: peripherique, Spondylite ankylosante
Foie = pericholangite 
Dermato: pyoderma gangrenosum, erythema nodosum
Yeux: uvéite, episclerite
42
Q

Mnemonic causes pancreatite

A 
I GET SMASHED
Idiopathic
Gallstones 45%
Ethanol 35%
Tumor: pancreas, choledoque, ampulla
Scorpion sting
Microbio: Bact (Mycoplasma, campylobacter, Tb, legionella), virua (Mumps, rubella, VZ, CMV, EBV, hepatite virale), parasite (ascariase, clonorchiase, echinocosis)
A-I: LED, polyarthrite noueuse, Crohn
Surgery or trauma
Hyperlipidemia (Tg >11.3), HyperCa, Hypothermia
Emboli or ischemia
Drugs or toxins: furosemide, TRH, methyldopa, bloc H2, acide valproique, ATB, acetaminophene, salicylate, steroides, azathioprine, mercaptopurine
43
Q

FR pancreatite

A

Tabagisme

44
Q

Critères dx pancreatite

A

Besoin >2/3

1) Dlr abdo caractéristique pancreatite aiguë
2) Amylase et/ou lipase 3x N (limite sup)
3) CT ou IRM c image typique

45
Q

Signes pancreatite hemorragique

A

Signe Grey turner = ecchymose au flanc

Signe cullen = ecchymose peri-ombilicale

46
Q

MC pancreatite chronique

A

Epigastralgie irrad au dos, +- No-Vo, dim assis penché vers l’avant, pire 15-30 min post-pandial
Possible insuffisance endo/exocrine indolore (perte >90% pancréas)
Possible asc

47
Q

Ddx cause obstructive pancreatite chronique

A 
1- Benin
  -dysfonction sphincter oddi
  -pancreas divisum
  - post-traumatique
2- malin: tumeur ampoule ou canaux
48
Q

Ddx causes pancreatite chronique non-obstructives

A 
ROH
Idiopathique 10-20%
Tropical
Genetique
Traumatique
A-I
Ischémie vasculaire
Metab: hyperTg ou Ca
49
Q

MC SHU

A

HUS
Hemorrage, Hemolytic anemia, Hemat/proteinurie
Heart and renal failure, HTA
Usually <10 yo, Uremia
Sensorium altered, seizure, Supportive line of tx

50
Q

Ddx augmentation ALP > ALT-AST

A
  1. Obstruction choledoque
  2. Destruction canaux microscopiques (cirrhose bili primitive)
  3. Defaut transport bile
  4. Infiltration du foie (metas, lymphome, granulome, amyloid)
51
Q

Ddx transaminases >1000

A 
Drogues
Hepatite virale
Hepatite A-I
Hepatite ischemique
Rare: calcul choledoque
52
Q

Ddx hepatite

A 
Infection virale
Roh
Drogues
Inmun
Toxines

Medicine (16 decks)

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